Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
L 1. A 64-year-old man presents with splenomegaly, lymphadenopathy, persistent fever, night sweats, and weight loss. Bone marrow aspiration and biopsy are scheduled. Which of the following would be the best place to sample bone marrow? A Iliac crest B Sternum C Scapula D Humerus E Tibia L2. A 16-year-old girl is brought into your orthopedic office because she fell off her bicycle while riding down a steep hill. You examine her left arm and can palpate a displaced midshaft break of her humerus. You note that she can not extend her wrist, but you do not feel any distal broken bones. She has limited ability to extend and abduct her arm at the shoulder. Her left forearm and hand feel slightly colder than her right arm and you note she seems to have lost some sensation on the posterior lateral portion of her left hand, though she says she can feel with all her fingertips. You are concerned that she has damaged which of the following? A Axillary nerve B Axillary nerve and posterior humeral circumflex artery C Radial nerve D Radial nerve and deep artery of the arm E Median nerve and brachial artery L3. A 73-year-old man presents because of repeated biting of his tongue and cheek, and difficulty chewing. The left side of his tongue is somewhat swollen and he has two different cuts on it. His left cheek is slightly less full over the angle of the mandible compared to the right side. He has very little sensation over his left mandible, along the side of his head, and on the left side of his tongue. He has weakened ability to elevate his mandible on the left side. Taste sensation on his tongue is normal. He also complains of slight dryness on the left side of his mouth. The rest of his cranial nerve examination is normal. A head CT is ordered because his physician suspects which one of the following? A A tumor at the left superior orbital fissure B A tumor blocking the left foramen rotundum C A tumor blocking left foramen ovale D A tumor blocking the left internal acoustic meatus E A tumor blocking the right internal acoustic meatus L4. A 10-year-old boy is brought into his pediatrician's office by his mother. The boy is supporting his left arm at the elbow by using his right hand because he thinks he has "broken his arm." The 10-year-old was playing tag and tripped over the curb and landed on the grass, catching himself with his hands. Upon physical examination, the pediatrician notes a slight drooping of the left shoulder when unsupported, and tenderness over the mid-clavicular region but no palpable fracture or displacement. The jugular notch appears symmetrical. The shoulder has normal movement, but the boy is unwilling to lift his hand above his head because it hurts. Otherwise, hand and arm movements are relatively normal with normal sensation. Anteroposterior and lateral x-rays of the thorax and upper arm are ordered because of suspicion of which one of the following? A Colles fracture B Scaphoid fracture C Fracture of the surgical head of the humerus D Dislocated sternoclavicular joint E Greenstick fracture of the clavicle L5. When examining a 48-year-old woman for the first time at a free clinic you note that she is quite slender and tanned. During the physical exam you note that she has prominent veins both on her anterior abdominal wall and also about her nose. During the physical exam you can palpate a fairly large firm organ that extends well below the right costal margin during both inspiration and expiration. There is no abdominal tenderness. Which of the following is the most likely explanation for your physical findings? A Splenomegaly B Hepatomegaly C Appendicitis D Cholecystitis E Abdominal aortic aneurysm L6. In a medial medullary syndrome that involves a left-sided branch of the anterior spinal artery, which of the following deficits is seen? A deviation of the tongue to the left, hemiplegia of arm and leg on the left B deviation of the tongue to the right, hemiplegia of arm and leg on the right C loss of conscious proprioception and precise tactile discrimination over the right side of the body exclusive of the face D only deviation of the tongue to the left E only hemiplegia on the right L7. A middle-aged person is referred to a neurologist after experiencing certain visual deficits. Through the use of an MRI and other diagnostic procedures, it is concluded that there is some damage to a part of his nervous system. The patient presented with a lateral gaze paralysis, in which both eyes were conjugatively directed to the side opposite the lesion. In this condition, which of the following is the locus of the lesion? A Root fibers of cranial nerve III B Nucleus of cranial nerve III C Root fibers of cranial nerve VI D Nucleus of cranial nerve VI E Nucleus of cranial nerve VI L8. A 15-year-old boy was struck in the face by a baseball thrown by the opposing pitcher in a baseball game. The next day, he experienced difficulty smiling and was unable to blink his eye in response to irritation caused by a piece of dirt that came into the eye. Which of the following cranial nerves was affected by this accident? A Nerve V B Nerve VI C Nerve VII D Nerve IX E Nerve X L9. When you examine the “corneal reflex” in a patient, you touch the cornea with the wisp of cotton that causes the eyelid of the touched eye to rapidly shut. Thus, as with most reflexes, you are testing both the afferent information that is carried back to the central nervous system and the reflex motor response. What specific cranial nerve branches are responsible for both the afferent and efferent parts of the corneal reflex? A Short ciliary nerve (CN III); zygomatic and temporal branches of the facial nerve (CN VII) B Short ciliary nerve (CN III); oculomotor nerve (CN III) C Long ciliary nerve (CN V1); zygomatic branches of the facial nerve (CN VII) D Long ciliary nerve (CN V1); infraorbital branch of the trigeminal nerve (CN V2) E Infraorbital nerve (CN V2); zygomatic branches of the facial nerve (CN VII) L10. A 12-year-old boy was riding his bicycle across an intersection when and elderly woman tried to pull out into the busy street just as the boy was riding in front of her, hitting the boy. Fortunately the boy landed on the hood of the car, but the bumper struck the boys legs just below the knee and created a very large cut. The boy presents to the emergency room bleeding and walking with a distinct left foot-drop. The boy has also lost most of his ability to flex his left ankle or evert his left foot and he has lost sensation on the lateral side of his leg distal to the cut. Plain films show that there are no broken bones and examination of the knee reveals that is appears intact. You call in a plastic surgeon, to reanastomose which of the following? A Sciatic nerve B Tibial nerve C Common fibular (peroneal) nerve D Deep fibular nerve E Obturator nerve L11. A 35-year-old man who had optic neuritis (an inflammation of the optic nerve causing blurred vision) several years before was told that he had a 50% chance of eventually developing multiple sclerosis (MS). One day he noticed that he had double vision and felt weak on his right side. Although he noted that the symptoms were becoming steadily worse throughout the day, he attributed this to stress from his job as a stockbroker, and in order to relax he decided to take a drive in his car. While he was driving, his vision became steadily worse. As he was about to pull over to the side of the road, he saw two trees on the right side of the road. Uncertain which was the actual image, he attempted to place his right foot on the brake pedal. He suddenly realized that he was unable to lift his right leg, and his car collided with the tree. A pedestrian on the side of the road called the emergency medical service (EMS), and the patient was brought to a nearby emergency room. A neurologist is called to see the patient because the emergency room physicians thought he might have had a stroke, despite his young age. The neurologist speaks to him, then examines him. He finds that his left eye was deviated to the left and down. When the patient attempts to look to his right, his right eye moves normally, but his left eye is unable to move farther to the right than the midline. His left pupil is dilated and does not contract to light from a penlight. His left eyelid droops, and he has difficulty raising it. In addition, the right side of his mouth remains motionless when he attempts to smile, but his forehead is symmetric when he raises his eyebrows. His right arm and leg are markedly weak. The neurologist tells the patient that he is not certain that this was necessarily a stroke, but admits him to the hospital for observation and tests. Which of the following muscles are affected by nerve damage, causing the patient’s left eye to be deviated toward the left side and down? A Superior rectus, superior oblique, inferior rectus, inferior oblique B Superior rectus, inferior rectus, inferior oblique, lateral rectus C Superior rectus, inferior rectus, inferior oblique, medial rectus D Lateral rectus, superior oblique, medial rectus, inferior rectus E Lateral rectus, superior oblique, inferior oblique, medial rectus L12. A 42-year-old woman is watching her son play baseball when a stray foul ball from another field unexpectedly strikes her in the back of the head and neck behind her left ear. A subcutaneous bulge rapidly appears, but she stays to watch the rest of the game and ices the bump when she arrives at home. The next day much of the swelling is diminished, but when she tries to eat an apple, or even when she swallows, it hurts deep behind her left ear. In addition, the patient reports the sensation of a foreign body in her throat and discomfort when turning her head. She travels to the urgent care clinic where the physician orders a lateral skull film that shows no fracture of her mastoid process. The styloid process is fractured and displaced from the skull. To which one of the following bones is the styloid process attached? A Ethmoid bone B Mandible C Occipital bone D Sphenoid bone E Temporal bone L13 As a result of an infection, a 56-year-old woman experiences a loss of taste affecting the front of her tongue and the ability to smile. If the sensory loss involves damage of cell bodies, which of the following specific group of neurons would be so affected? A Otic ganglion B Nodose (inferior) ganglion C Pterygopalatine ganglion D Geniculate ganglion E Trigeminal ganglion L14. A patient displays the following constellation of symptoms: UMN paralysis of the left leg, paralysis of the lower half of the left side of the face, and a left homonymous hemianopsia. Which of the following regions most likely contains the lesion? A Medulla B Basilar pons C Pontine tegmentum D Midbrain E. Forebrain L15. An 18-year-old male patient was thrown from a horse and suffered extensive damage to the back and pelvic region. After 2 weeks of recovery, it is noted that the patient has a spastic neurogenic urinary bladder. Although the patient is unable to initiate micturition, the bladder periodically empties itself. Where is the lesion affecting control of the bladder in this patient located? A cauda equina B spinal cord, above the level of S2 C spinal cord, at the level of S2 D spinal cord, at the level of S3 E spinal cord, at the level of S4 L16. A mammogram of a woman, age 48, reveals macrocalcification within the right upper, lateral quadrant of the breast, indicating the need for a biopsy. The surgeon closely examines the nipple for indications of ductal carcinoma. At surgery for the biopsy, a locator needle is inserted into the region of macrocalcification and the position confirmed by mammography. The surgeon incises the skin and dissects a block of tissue. The pathology report indicates ductal carcinoma with microinvasion necessitating surgery. Both patient and surgeon agree that a modified radical mastectomy offers the best prognosis in her case. At surgery for mastectomy, the surgeon carries the dissection along the major pathway of lymphatic drainage from the mammary gland. The major lymphatic channels parallel which one of the following? A Subcutaneous venous networks to the contralateral breast and abdominal wall B Tributaries of the axillary vessels to the axillary nodes C Tributaries of the intercostal vessels to the parasternal nodes D Tributaries of the internal thoracic (mammary) vessels to the parasternal nodes E Tributaries of the thoracoacromial vessels to the apical (subscapular) nodes L17. When examining an axial/horizontal CT of the chest, remember that the origin of the pulmonary trunk just cranial to the right ventricle starts out where? A Anterior and to the left of the ascending aorta B Posterior and to the left of the ascending aorta C Anterior and to the right of the ascending aorta D Anterior and to the left of the aorta E None of above L18. A 72-year-old male who had been suffering with diabetes for approximately 20 years was seen by a neurologist because of complaints about discomfort around his leg and difficulty in walking. The neurologist reported that the patient displayed weakness of extension of the leg, fixation of the knee, and some wasting of the quadriceps muscle. Which of the following is the most likely anatomical structure that was injured and responsible for these symptoms? A Sciatic nerve B Tibial nerve C Peroneal nerve D Femoral nerve E Lateral cutaneous nerve L19. A 55-year-old woman arrives at the emergency department the day after St. Patrick's Day coughing up bright red blood. History includes excessive alcohol consumption. Using abdominal percussion it is determined that her liver extends 5 cm below the right costal margin at the mid-clavicular line. A gastroenterology consult is ordered because of suspicion that the bright red blood is most likely the result of which one of the following? A Hemorrhoids B Colon cancer C Duodenal ulcer D Gastric ulcer E Esophageal varices L20. After a night of fraternity parties, a 21-year-old college junior came to the ER the following morning complaining that she could not raise her wrist. There was no history of trauma. On examination, the patient could not extend her fingers or wrist but could flex them. She could also both flex and extend her elbow normally. There were no other motor deficits. The symptoms suggest damage to which of the following? A Median nerve B Ulnar nerve C Radial nerve D Axillary nerve E Musculocutaneous nerve L21 . In the male, the homologue of the vaginal artery is which of the following? A Obturator artery B nternal pudendal artery C Middle rectal artery D Umbilical artery E Inferior vesical artery L22. An 8-year-old boy returns to the pediatric clinic because he has a "pain in his butt" and walks with a limp. He just visited the clinic a few days ago for a normal summer checkup and an update on his vaccinations. When the physician asks how this happened, the boy says that the pain started when the nurse gave him his booster shot in his left buttock. When he walks, he drops his right hip as he places all the weight on his left leg and swings his right leg forward. When lying prone on the examination table both legs flex normally with equal strength, and he can extend his thigh at the hip well, but there is flaccidity of his muscles just under the iliac crest only on the left side. The pediatrician tells the boy and his mother that the booster shot he received a couple of days ago likely damaged which one of the following? A Lateral cutaneous nerve of the thigh causing his pain B Superior gluteal nerve partially paralyzing his gluteus medius muscle C Superior gluteal nerve partially paralyzing his gluteus maximus muscle D Inferior gluteal nerve partially paralyzing his gluteus medius muscle E Sciatic nerve partially paralyzing his hamstring muscles L23. A 48-year-old female patient is brought to the emergency room by her husband. He reports that his wife suffers from hypertension but, as a high-level executive with a lot of pressure at work, she has been neglecting to take her medication. This morning, as he entered the garage to leave for work, he found his wife lying on the ground next to her own car. She was experiencing uncontrolled flailing of the left arm and leg. What is the most likely site of brain lesion in this patient? A anterior limb of the left internal capsule B anterior limb of the right internal capsule C cerebellum D left subthalamic nucleus of Luys E right subthalamic nucleus of Luys L24. A physician examines a patient who complains of pain and paresthesia in the left leg. The distribution of the pain, running down the lateral aspect of the leg and the dorsal surface of the foot, is suggestive of a herniated intervertebral disk. The physician links the distribution of symptoms with nerve L5 and concludes that herniation has occurred at which location? A L3–L4 intervertebral disk B L4–L5 intervertebral disk C L5–S1 intervertebral disk D S1–S2 intervertebral disk E Insufficient data to determine L25. A 62-year-old male is hospitalized for a stroke which caused an inability to move his right eye to the right, and a partial paralysis of the limbs on the left side. Which of the following combinations of structures were most likely affected by this cerebral occlusion? A Cranial nerve VI and basilar pons B Cranial nerve VI and pontine tegmentum C Cranial nerve III and cerebral peduncle D Cranial nerve III, red nucleus, and cerebral peduncle E Motor regions of the cerebral cortex and frontal eye field L26. A 53-year-old male was diagnosed with a tumor localized to the thalamus that disrupted most but not all types of sensations. Which of the sensations listed below would still function despite of the presence of the tumor? A Conscious proprioception B Taste C Olfaction D Vision E Audition L27. A 42-year-old woman underwent LASIK for myopia in both her eyes. In LASIK, the shape of the cornea is flattened. This will result in which of the following? A Decreased refraction of light by the cornea B A decreased amount of light entering through the cornea C Conversion of the cornea from a "stationary" to an "adjustable" form of refraction D Maintenance of the lens in a more flattened state E Focusing of light on the retina at a point other than the fovea L28. A 19-year-old woman has been admitted through the emergency department to the obstetrics service because she is in stage I of labor. She is about 38 weeks into the pregnancy, but she has not had any previous contact with healthcare other than obtaining some prenatal vitamins. She is in a great deal of pain and requests pain relief, but still wants to fully and actively participate in labor despite never delivering or attending birthing classes before. The obstetrician decides on a pudendal nerve block. What landmarks would be used to perform the procedure in this woman? A Ischial tuberosity; location of the pudendal canal B Ischial spine; location of the pudendal nerve C Sacrotuberous ligament; location of the pudendal nerve D Pubic symphysis; location of the pudendal canal E Tip of the coccyx; location of the pudendal nerve L29. A 68-year-old female was admitted to the emergency room following an inability to move her left eye to the left, as well as a failure to show a smile on the left side of her face. However, she experienced no loss of taste from any part of her tongue. Damage to which of the following structures would most likely account for these deficits? A The trigeminal and abducens nerves B The facial and trigeminal nerves, distal to their exit from the brainstem C The facial and abducens nerve nuclei within the pons D The facial nerve, distal to the chorda tympani nerve E The facial nerve, distal to the geniculate ganglion L30. A woman presents with gallstones and no jaundice. She is prepared for exploratory surgery. The lesser omentum is incised close to its free edge, and the biliary tree is identified and freed by blunt dissection. The liquid contents of the gallbladder are aspirated with a syringe, the fundus incised, and the stones are removed. The entire duct system is carefully probed for stones, one of which is found to be obstructing a duct. In view of her symptoms, where is the most probable location of the obstruction? A The bile duct B The common hepatic duct C The cystic duct D Within the duodenal papilla proximal to the juncture with the pancreatic duct E Within the duodenal papilla distal to the juncture with the pancreatic duct L31 . An elderly resident of a nursing home fell down the front steps and subsequently became disoriented and lethargic. He is brought to the emergency room where an emergency MRI reveals that he has developed hydrocephalus due to a small hemorrhage obstructing the foramina of Monro. The foramina of Monro allow for communication between which of the following? A fourth ventricle and cerebral aqueduct B fourth ventricle and subarachnoid space C lateral ventricles and third ventricle D third ventricle and cerebral aqueduct E third ventricle and fourth ventricle L32. An individual experiences an ipsilateral paralysis of the soft palate and pharynx, producing hoarseness and dysphagia (inability to swallow) and, in addition, displays a loss of the carotid sinus reflex. Which of the following nerve groups is most likely affected? A Cranial nerve XII B Cranial nerve XI C Cranial nerve X D Cranial nerve VII E Ventral horn cells of the cervical cord L33. A negative pressure drain (chest tube) must be inserted into the pleural space in order to remove either fluid or air that normally is not present. Effective locations for the drain include which of the following? A Apex between the clavicle and first rib B Costomediastinal recess on the left, adjacent to the xiphoid process C Right fourth intercostal space in the midclavicular line (just below the nipple) D Right sixth intercostal space in the midaxillary line E Right eighth intercostal space in the midclavicular line (about 4 in. below the nipple) L34. A 70-year-old male was brought to the emergency room after experiencing headaches, nausea, and dizziness. An MRI revealed the presence of a brain tumor, which had produced a noncommunicating hydrocephalus. Which of the following is the most likely location of the tumor? A Cerebral subarachnoid space B Cistern of the lamina terminalis C Interventricular foramen D Pontine cistern E Cisterna magna L35. A 64-year-old woman is admitted to the emergency room after she experienced dizziness. Several days later, a neurological examination reveals that the patient is unable to move her right eye medially. Which of the following is the likely locus of the lesion? A Dorsal medulla B Ventromedial medulla C Dorsal pons D Ventromedial pons E Medial midbrain L36. You have a patient who has renal failure as a result of Alport’s syndrome. While he is currently on dialysis, he is hoping to receive a transplanted kidney. He asks you if they are going to remove one of his bad kidneys and put the new transplanted kidney back in the same place. You tell him which of the following? A The right kidney is always removed since it is more inferior and easier to remove and the new kidney will go in its place B The left kidney will be removed because it is easier to move the descending colon out of the way and the newly transplanted kidney will go in its place C He will keep both of his kidneys, and the newly transplanted kidney will be placed on the left posterior wall just inferior to his left kidney since there is more room because the left kidney is higher D The newly transplanted kidney will be placed in the iliac fossa in the greater pelvis, attached to branched iliac vessels and the ureter connected directly to the bladder E None of above L37. A second-year medical student was asked to see a nursing home patient as a requirement for a physical diagnosis course. The patient was a 79-year-old man who was apparently in a coma. The student was not certain how to approach this case, so he asked the patient's wife, who was sitting at the bedside, why this patient was in a coma. The wife replied, "Oh, he isn't in a coma. But he did have a stroke." Slightly confused, the student leaned over and asked the patient to open his eyes. He opened his eyes immediately. However, when asked to lift his arm or speak, the patient did nothing. The student then asked the patient's wife whether she was certain that his eye opening was not simply a coincidence and whether he really was in a coma, since he was unable to follow any commands. The wife explained that he was unable to move or speak as a result of his stroke. However, she knew that he was awake because he could communicate with her by blinking his eyes. The student appeared rather skeptical, so the patient's wife asked her husband to blink once for "yes" and twice for "no." She then asked him if he was at home, and he blinked twice. When asked if he was in a nursing home, he blinked once. The student then asked him to move his eyes, and he was able to look in his direction. However, when the student asked him if he could move his arms or legs, he blinked twice. He also blinked twice when asked if he could smile. He did the same when asked if he could feel someone moving his arm. The student thanked the patient and his wife for their time, made notes of his findings, and returned to class. Which of the following arteries could have been subjected to an infarct that would account for the lesion described in this case? A Anterior spinal artery B Vertebral artery C Basilar artery D Middle cerebral artery E Posterior cerebral artery L38. A patient is observed to suffer from hypoglossal hemiplegia. There is atrophy of the tongue on the right side and deviation of the protruded tongue to the right. In addition, the patient exhibits upper motor neuron paralysis of the left side of the body. Deviation of the tongue toward the right involves which of the following? A Left nucleus ambiguus B Left pyramidal tract caudal to the decussation C Right hypoglossal nerve D Right nucleus ambiguus E Right pyramidal tract rostral to the decussation L39. As a result of a hemisection of the spinal cord, a patient has loss of vibration and position sense in the right leg. Which of the following pathways was affected by the lesion? A Right fasciculus cuneatus B Right fasciculus gracilis C Left fasciculus cuneatus D Left fasciculus gracilis E Right Lissauer tract L40. An individual experienced the following constellation of symptoms following a brainstem lesion associated with a stroke of that region: hoarseness, difficulty in swallowing, diminished gastric secretions, and loss of some cardiovascular reflex functions. To which of the following structures can these symptoms be attributed? A Cranial nerve VII B Cranial nerve IX C Cranial nerve X D Cranial nerve XI E Pontine reticular formation L41. During surgical resection of the gastrointestinal tract for treatment of long-standing irritable bowel syndrome, a surgery resident is asked to select a surgical site coinciding with the termination of the vagal innervation. Which of the following does she select? A duodenojejunal junction B ileocolic junction C junction of the second part and third part of the duodenum D left colic (splenic) flexure E right colic (hepatic) flexure L42. Concerning a case in which a patient presents with sensory neglect, one characteristic is that the patient does not blink his eye in response to the waving of the neurologist’s hand in his left temporal visual field. Damage to which of the following nerve fibers most likely accounts for this component of the overall deficit? A Left facial nerve B Right oculomotor nerve C Left optic nerve D Optic chiasm E Right optic radiations L43. An 83-year-old female was admitted to the emergency room following a stroke. Sometime after she regained consciousness, a neurological examination revealed that the application of mild tactile stimulation on the right arm was extremely painful, while the remainder of the neurological exam was relatively normal for an individual of her age. Where was the most likely locus of the stroke? A Right precentral gyrus B Left precentral gyrus C Right ventroposterolateral thalamus D Left ventroposterolateral thalamus E Left ventroposteromedial thalamus L44. An 18–year-old male is hit on the side of his head, including the face region, as a result of being tackled in a football game. The next day, he has trouble displaying expression on the right side of his face. He is seen by a neurologist. During the examination, he is asked to protrude his tongue and it does not deviate to either side, but if he closes his eyes and sugar water is placed on the right side of the anterior portion of his tongue, he cannot identify it. Where was the damage that most likely produced the defect in taste in the anterior two-thirds of his tongue? A Trigeminal ganglion B Proximal aspect of glossopharyngeal nerve C Distal aspect of lingual nerve D Solitary nucleus E Proximal aspect of the chorda tympani nerve L45. A 19-year-old female college student presents to the emergency room at 10:30 pm on a Friday night with severe left side, back, and pelvic pain. While she has never had them before, she states that she thinks she has kidney stones. The pain started in her mid back about a week ago and then subsided and now the pain has decreased somewhat and also extends down into her labia majora. She is on birth control pills, but denies any sexual activity. She is having her period, but denies the pain is menstrual. You have her do a urine pregnancy test while she is waiting to get an abdominal and pelvic computer tomography (CT) to look for ureteric calculi. What specific location(s) will you look for in the CTs for obstructing calculi? A At the junction of the renal pelvis with the ureters B As the ureters cross the cranial edge of the greater pelvis C As the ureters cross the external iliac artery at the pelvic brim D As the ureters pass through the wall of the bladder E A, B, and C F A, C, and D L46. In examining a 30-year-old male patient with multiple sclerosis, you notice that when you ask the patient to look to the left, the right eye fails to adduct and when the patient looks to the right, the left eye fails to adduct. However, both eyes in the patient can adduct during convergence. There is no noticeable strabismus when the eyes are focused on a far point. During abduction, both eyes display nystagmus. You record on the patient's chart a diagnosis of bilateral internuclear opthalmoplegia. Which of the following neural structures is affected? A Fourth cranial (trochlear) nerve B Medial longitudinal fasciculus (MLF) C Second cranial (optic) nerve D Sixth cranial (abducens) nerve E Third cranial (oculomotor) nerve B L47. Your young female patient has a large bulge on the anterior thigh below the inguinal ligament. You suspect an abdominal hernia that has passed through the femoral ring into the femoral sheath and then through the saphenous hiatus into the subcutaneous layer of the upper thigh. In addition to the hernial sac, you would expect the femoral canal to contain which of the following? A connective tissue and lymph nodes B femoral artery C femoral nerve D femoral vein E great saphenous vein L48. A 72-year-old male experiences difficulty in walking downstairs and reports some double vision as well. In this instance, which of the following is the most likely locus of the lesion? A Medulla B Dorsal pons C Ventromedial pons D Midbrain E Spinal cord L49. A 57-year-old man who has always been a very heavy drinker, often consuming two pints of whiskey per day, for many years, notices that he now needs to stand with his feet far apart in order to maintain his balance and that he waddles when he walks. The doctor who evaluates him tests his memory and speech carefully, as well as his cranial nerves, and is unable to find any deficits. There is no weakness, sensory loss, or abnormalities in his reflexes. When asked to touch the doctor's finger and then his nose, the patient misses his nose slightly, but rapidly corrects the movement on both sides. When asked to slide his right heel down his left shin, his heel slides sideways and clumsily across the bone until it reaches his ankle. The response with the left heel is similar. When asked to walk, the patient walks with his feet very far apart. If he tries to walk in a tandem fashion, with one heel in front of the other toe, he begins to fall, and the doctor has to catch him. The doctor orders an MRI of the patient's head. A gait problem of this type could be caused by lesions in which of the following systems? A Cerebellar tracts only B Posterior columns only C Corticospinal tracts D Both the cerebellar and the posterior column systems E Spinothalamic system L50 Due to the presence of a tumor, a patient reports that he is unable to experience the sense of taste from the anterior two-thirds of his tongue. Which of the following structures is most likely affected by the tumor? A Motor nucleus of the cranial nerve VII B Inferior and superior ganglia of cranial nerve IX C Cell bodies of the geniculate ganglion of cranial nerve VII D Nucleus ambiguus of inferior ganglion of cranial nerve IX E Dorsal motor nucleus of the cranial nerve X L51. Internal bleeding can be a rare complication of a broken clavicle if the broken bone fragment becomes significantly displaced and tears a vessel and punctures the pleura. Normally the subclavius muscle protects the underlying vessels. Which one of the following vascular structures is particularly vulnerable in a displaced clavicular fractures? A Subscapular artery B Cephalic vein C Lateral thoracic artery D Subclavian vein E Thoracocervical trunk L52. Which of the following contains the ovarian neurovascular bundle? A Broad ligament B Mesosalpinx C Mesovarium D Suspensory ligament of the ovary E Transverse cervical ligament L53. An 8-year-old boy returns to your pediatric clinic because he has a “pain in his butt” and walks with a limp. He had just been at your office a couple of days ago for a normal summer check up and an update on his vaccinations. When you ask him how this happened the boy said that the pain all started when your nurse gave him his booster shot in his left buttock. You have him demonstrate his walk and you notice that he drops his right hip as he places all the weight on his left leg and swings his right leg forward. You place him prone on the examination table and test the strength of his ability to extend each thigh at the hip and flex his leg at the knee. Both legs flex normally with equal strength, and he can extend his thigh at the hip well, but you notice some falsity of his muscles just under the iliac crest on the left side only. You tell the boy and his mother that the booster shot he got a couple of days ago likely damaged which of the following? A Lateral cutaneous nerve of the thigh giving him his pain B Superior gluteal nerve partially paralyzing his gluteus medius muscle C Superior gluteal nerve partially paralyzing his gluteus maximus muscle D Inferior gluteal nerve partially paralyzing his gluteus medius muscle E Sciatic nerve partially paralyzing his hamstring muscles L54. A 55-year-old male had been complaining about his having difficulty in coordinating the use of his arms in meaningful ways. For example, when examined by a neurologist, the patient was unable to move his finger accurately to his nose from his side when requested to do so but instead would undershoot or overshoot the target. He also had difficulty in making rapid alternating rotational movements of the hand. The neurologist believed that the patient was suffering from a disorder that resulted in a lesion of a region of the cerebellum or structures related to it. Which of the following regions most likely contained this lesion? A Fastigial nucleus B Vermal region C Cerebellar hemsipheres D Inferior cerebellar peduncle E Vestibular nuclei L55. A 27-year-old man is admitted for neurologic evaluation of a gunshot wound received 5 days previously. A 9-mm bullet had passed through both the medial and lateral heads of the gastrocnemius muscle. The exit wound on the lateral head of the muscle was somewhat deeper than the entrance wound in the medial head. The bullet did not strike bone or significant arteries although significant tissue damage, suppuration, and swelling were found around the exit wound. Neurologic examination reveals losses of dorsiflexion and eversion of the left foot. The patient cannot feel pinprick or touch on the dorsum of the left foot or anterolateral surface of the left leg. Which nerve was most likely involved in the injury? A Sciatic nerve B Femoral nerve C Sural nerve D Common fibular (peroneal) nerve E Tibial nerve L56. You deliver a full-term baby boy who is otherwise normal, but has a left cleft of the upper lip that extends upward toward the left nostril and left anterior cleft of the primary palate just deep to the cleft lip. You explain to the mother that these defects are most likely due to a failure of which of the following? A Mandibular process to fuse with the lateral nasal process B Mandibular process to fuse with the medial nasal process C Maxillary process to fuse with the lateral nasal process D Maxillary process to fuse with the medial nasal process E Lateral and medial nasal processes to fuse with each other L57. Sympathectomy may occasionally relieve intractable pain of visceral origin, since visceral afferent pain fibers run along the sympathetic pathways in the abdomen. The autonomic control of peristalsis in the descending colon should not be affected by bilateral lumbar sympathectomy for which one of the following reasons? A The descending colon is controlled chiefly by parasympathetic innervation from the pelvic splanchnic nerves B The descending colon receives its parasympathetic innervation from the vagus nerve. C The descending colon receives its sympathetic innervation from thoracic splanchnic nerves. D Lumbar splanchnics from L1, L2, and L3 only innervate the pelvic viscera via the hypogastric nerve. E Only presynaptic sympathetic fibers have been severed. L58. Coronary artery disease is a frequent cause of myocardial infarction in the United States. If an echocardiogram suggests reduced posterior ventricular wall movement, there will be reduced blood flow within which of the following coronary arteries and veins? A Circumflex branch of the left artery; great cardiac vein B Anterior interventricular artery; great cardiac vein C Anterior interventricular artery; middle cardiac vein D Right marginal branch of the right artery; small cardiac vein E Posterior interventricular artery; middle cardiac vein L59. Fractures of the humerus in different regions have the potential to damage different nerves. What muscle innervation may be compromised by a fracture of the humerus at the “surgical neck”? A Subscapularis B Pectoralis major C Teres major D Deltoid E Suprascapularis L60. Coronary arteries supply blood to the myocardium and pacemaker centers of the heart from branches that come off either the right or left coronary arteries. While some regions of the myocardium may receive blood from two different coronary arteries, the pacemaker centers of the heart normally only receive blood from a single coronary artery, but the pattern varies in the human population. The blood supply to the sinoatrial (SA) and atrioventricular (AV) nodes is derived from which coronary artery(ies)? A Both the SA and AV nodes receive blood from the right coronary artery or its branches. B Both the SA and AV nodes receive blood from the left coronary artery or its branches. C In 60% of the population, the SA node receives its blood from the right coronary artery. In 85% of the population, the AV node receives its blood from the right coronary artery via the posterior interventricular artery. D In 15% of the population, the SA node receives its blood supply from the right coronary artery. In 15% of the population, the AV node receives its blood supply from the right coronary artery via the posterior interventricular artery. E In 60% of the population, the SA node receives its blood supply from the left coronary artery. In 85% of the population, the AV node receives its blood supply from the left coronary artery via the posterior interventricular artery. L61. A 72-year-old male experiences difficulty in walking downstairs and reports some double vision as well. In this instance, which of the following is the most likely locus of the lesion? A Medulla B Vermal region C Ventromedial pons D Midbrain E Spinal cord L62. A 53-year-old woman has a paralysis of the right side of her face that produces an expressionless and drooping appearance. She is unable to close her right eye, has difficulty chewing and drinking, perceives sounds as annoyingly intense in her right ear, and experiences some pain in her right external auditory meatus. Physical examination reveals loss of the blink reflex in the right eye on stimulation of either cornea and loss of taste from the anterior two-thirds of the tongue on the right. Lacrimation appears normal in the right eye, the jaw-jerk reflex is normal, and there appears to be no problem with balance. The inability to close the right eye is the result of involvement of which of the following? A Zygomatic branch of the facial nerve B Buccal branch of the trigeminal nerve C Levator palpebrae superioris muscle D Superior tarsal muscle (of Müller) E Orbital portion of the orbicularis oculi muscle L63. Both the autonomic and vascular systems need to function properly for successful male sexual function. Which one of the following statements concerning erection, emission, and ejaculation in the male is correct? A Contraction of the internal urethral sphincter is under control of the parasympathetic nervous system. B The parasympathetic nerves stimulate closure of helicine arteries. C Sympathetic neurons stimulate the helicine arteries to dilate and increase blood flow to the corpora cavernosum. D Parasympathetic innervation stimulates emission of seminal fluid. E Contraction of the bulbospongiosus muscles impedes the drainage of blood from the corpus spongiosum. L64. An elderly male patient in a hospital suffered an extensive stroke following a procedure to repair a defect in a heart valve. When the patient regained consciousness, a neurological examination revealed a paralysis of his left arm and leg, as well as inability to recognize a pin prick or tuning fork on his left leg or arm. Other sensory and motor functions of the face appeared normal. Which of the following constitutes the most likely regions damaged by the stroke? A Prefrontal and primary motor cortices B Primary motor and somatosensory cortices C Premotor and posterior parietal cortices D Genu of internal capsule E Inferior and middle frontal gyri L65. Which of the following is the principal supply to the body and tail of the pancreas? A Common hepatic artery B Inferior phrenic artery C Left gastric artery D Splenic artery E Superior mesenteric artery L66. A tumor in the infratemporal fossa may gain entrance to the orbit through which of the following? A The optic canal (foramen) B The inferior orbital fissure C The pterygoid canal D The ethmoidal sinuses E The superior orbital fissure L67. A man presents with a wide-based, ataxic gait during his attempts at walking. He is also unsteady, sways when standing, and displays a tendency to fall backward or to either side in a drunken manner. In which of the following structures is a lesion most likely located? A Hemispheres of the posterior cerebellar lobe B Anterior limb of the internal capsule C Dentate nucleus D Anterior lobe of the cerebellum E Flocculonodular lobe of the cerebellum L68. A 55-year-old male had been complaining about having difficulty in coordinating the use of his arms in meaningful ways. For example, when examined by a neurologist, the patient was unable to move his finger accurately to his nose from his side when requested to do so but instead would undershoot or overshoot the target. He also had difficulty in making rapid alternating rotational movements of the hand. The neurologist believed that the patient was suffering from a disorder that resulted in a lesion of a region of the cerebellum or structures related to it. The neurologist believed that the neurological deficit was due to the lack of feedback from the affected structure to its target region elsewhere in the central nervous system. Which region is most likely devoid of this critical input? A Reticular formation B Vestibular nuclei C Basal ganglia D Cerebral cortex E Inferior olivary nucleus L69. A patient with Bell’s palsy has difficulty keeping food in her mouth while chewing and often drools from one side of her mouth. She also notes changes to the taste of her food. This last sign or symptom indicates inflammation along the peripheral course of the cranial nerve-affected fibers whose cell bodies are located in which ganglion? A Geniculate ganglion B Otic ganglion C Pterygopalatine ganglion D Submandibular ganglion E Trigeminal ganglion L70. A physician witnesses a choking incident in a restaurant. The Heimlich maneuver is unsuccessful at removing the food from the pharynx. The victim is having extreme difficulty breathing and starts to pass out. Where is the best location to produce an emergency airway? A In the midline just superior to the hyoid bone B In the midline just inferior to the hyoid bone C At the laryngeal notch D At the junction between the thyroid cartilage and cricoid cartilage E At tracheal ring 2 to 3 below the cricoid cartilage L71. When a patient is asked to follow an object placed in the right side of his visual field, he is unable to move his right eye either up or down. Which of the following regions would most likely contain the lesion? A Medulla B Basilar aspect of the pons C Pontine tegmentum D Midbrain E Cerebellum L72. The central nervous system floats in cerebrospinal fluid. This fluid is largely produced in the choroid plexus within the ventricular system and should have a pressure of less than 20 cm of water. The arachnoid villi allow cerebrospinal fluid to pass between which of the following two spaces? A Choroid plexus and subdural space B Subarachnoid space and subdural space C Subarachnoid space and superior sagittal sinus D Subdural space and cavernous sinus E Superior sagittal sinus and jugular vein L73. An individual suffers a severe injury that results in the crushing of the peripheral nerves that normally enter the spinal cord at levels C7–T1, causing both motor and sensory loss. Which of the following regions would most likely be affected by the injury? A Back of the head B Neck C Shoulder D Hand E Back L74. Detection of angular acceleration is accomplished by which of the following structures? A Maculae of the utricle and saccule B Hair cells of the organ of Corti C Cristae ampullaris of the semicircular canals D Interdental cells E Pillar cells L75. During the first 5–7 days of life, the umbilical vein can be catherized and used for central venous pressure monitoring. The umbilical vein leads to which of the following vessels? A descending aorta B ductus arteriosus C ductus venosus D inferior vena cava E portal vein L76. A 12-year-old boy was riding his bicycle across an intersection when an elderly woman tried to pull out into the busy street just as the boy was riding in front of her, hitting the boy. Fortunately the boy landed on the hood of the car, but the bumper struck the boys legs just below the knees and created a very large cut. The boy presents to the ED bleeding and walking with a distinct left foot-drop. The boy has also lost most of his ability to flex his left ankle or evert his left foot and he has lost sensation on the lateral side of his leg distal to the cut. Plain films show that there are no broken bones and examination of the knee reveals that it is intact. A plastic surgeon is consulted to reanastomose which one of the following? A Sciatic nerve B Tibial nerve C Common fibular (peroneal) nerve D Deep fibular (peroneal) nerve E Obturator nerve L77. The anterior two-thirds of the tongue differ from the posterior one-third of the tongue by its special visceral afferent (SVA; taste) innervation. The perikarya of neurons providing the sensation of taste in the anterior two-thirds of the tongue are found in which of the following? A geniculate ganglion B otic ganglion C pterygopalatine (sphenopalatine) ganglion D submandibular ganglion E trigeminal (gasserian) ganglion L78. As a result of calcification of the internal carotid artery, which impinged upon the lateral half of the right optic nerve prior to its entrance to the brain, a 68-year-old woman experienced certain visual deficits. Which of the following is the most likely visual deficit? A Total blindness of the right eye B Right nasal hemianopsia C Right homonymous hemianopsia D Right bitemporal hemianopsia E Right upper homonymous quadrantanopia L79. After examining a patient, a neurologist concluded that he suffers a stroke involving the dorsolateral medulla. Which of the following deficits did the neurologist see that allowed him to reach this conclusion? A Loss of pain and thermal sensation on the ipsilateral half of the face B Loss of pain and temperature sensation on the ipsilateral side of the body C Dysphonia D Hemiparesis E Intention tremor L80. Gallbladder pain often presents as epigastric pain that subsequently migrates toward the patient's right side and can even wrap around to the posterior. The somatic location of the referred pain is not the site of the problem. Anatomically where is the gallbladder located? A Between the left and caudate lobes of the liver B Between the right and quadrate lobes of the liver C In the falciform ligament D In the lesser omentum E In the right anterior leaf of the coronary ligament L81. A 37-year-old rural female patient developed pain in the lower abdomen and pelvic regions. Her physician suspects a ruptured ectopic pregnancy. However, because of the isolation of the rural community, no medical imaging or laboratory procedure is available and the physician decides to perform a culdocentesis. In the latter procedure, the needle will aspirate from which of the following spaces? A ovarian fossa B rectouterine pouch C uterine body D uterine cervix E vesicouterine pouch L82. Which of the following is considered a primary output of the VA nucleus? A Prefrontal and premotor cortices B Precentral and postcentral gyri C Posterior parietal lobe D Middle temporal gyrus E Wernicke’s area L83. A 19-year-old female college student presents to the emergency department at 10:30 PM on a Friday night with severe left-sided flank and pelvic pain. While she has never had similar pain, she states that she thinks she has a kidney stone. The pain started in her mid back about a week ago and then subsided and now the pain has increased and moved inferiorly along her flank and also extends down into her labia majora. She is taking birth control pills, but is not currently sexually active. She is having her period, but denies the pain is menstrual. Abdominal and pelvic CT are ordered. What two specific locations will one look for in the CTs for obstructing calculi? A At the junction of the renal papilla with the minor calyx and junction of the renal papilla with the major calyx B As the ureter leaves the kidney and as the ureter forms the infundibulum C As the ureter crosses the edge of the false pelvis and as the ureter crosses the edge of the true pelvis D As the ureter crosses the external iliac artery at the pelvic brim and as the ureter passes through the wall of the bladder E As the ureter passes through the wall of the bladder and as the ureter passes through the center of the trigone of the bladder L84. Based upon your knowledge of the anatomic and neurophysiological relationships of the anterior lobe of the cerebellum, which of the following best describes what would occur following electrical stimulation of the medial vermal aspect of the cerebellar cortex of the anterior lobe? A Produce movement of the arms B Produce spasticity C Cause tonic seizures to occur D Modulate extensor muscle tone E Have little effect upon muscle tone L85. A 59-year-old male suffered a stroke and later presented with a spastic paralysis. Which of the following structures was affected by the stroke that accounts for the spasticity? A Ventral horn cells B Corpus callosum C Postcentral gyrus D Internal capsule E Substantia nigra L86. A patient with a developing astroglioma in the primary auditory cortex (Brodmann's area 41) complains of hearing unusual noises. What is the main source of subcortical input to the primary auditory cortex? A inferior colliculus B lateral geniculate nucleus C medial geniculate nucleus D superior colliculus E superior olivary nucleus Answers of questions from liying L1 A, L2 D, L3 C , L4 E , L5 B , L6 C , L7 D , L8 C , L9 C, L10 C, L11 C ,L12 E, L13 D, L14 E, L15 B, L16 B ,L17 C, L18 D, L19 E L20 C L21 E, L22 B, L23 ,L24 B, L25 A, L26 C ,L27 A, L28 B, L29C, L30 C L31 C, L32 C, L33 D, L34 C, L35 E, L36 D, L37 C, L38 C L39 B L40 C L4 D, L42E, L43D ,L44E, L45 F , L46 B, L47 A, L48 D, L49 D,L50 C L51 D, L52 D, L53 B, L54 C, L55 D, L56 D, L57 A L58 E L59 D L60 C L61 D ,L62 A ,L63 E, L64 B, L65 D, L66 B, L67 E L68 D L69 A L70 D L71 D, L72 C, L73 D, L74 C,L75 C,L76 C, L77 A, L78 B, L79 A L80 B L81 B L82 A L83 D L84 D L85 D L86 C